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xB15W1 > INFLAMMATION OF THE GUT > Flashcards

INFLAMMATION OF THE GUT Flashcards

1
Q

what is the histology of the small intestine?

A

columnar epithelium with goblet cells and enterocytes. Paneth cells sit at the base of crypts. There are intraepthelial lymphocytes, peyers patches and Brunners glands (only in duodenum)

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2
Q

whats the function of paneth cells?

A

they contain eosinophilic lysozyme-rich granules so probably regulate cell proliferation and differentiation

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3
Q

what is the function of Peyer’s patches?

A

immune surveillance of materials within your digestive system

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4
Q

what is the function of Brunners glands in the duodenum?

A

secrete mucus with an alkaline pH, which serves to neutralize chyme from the stomach.

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5
Q

whats the histology of the large intestine?

A

Simple columnar epithelium lines its mucosa. The crypts of Lieberkühn are deeper in the colon and goblet cells become more abundant.
there are no villi, plicae circularis, or Paneth cells

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6
Q

what are the 5 layers of the digestive tract?

A 
mucosa
submucosa
muscular layer
subserosa - outside muscle coat mostly fat
serosa - shiny layer of peritoneum
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7
Q

what are some abdominal symptoms?

A

change in bowel habit
pain and discomofrt
wind
distention

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8
Q

what is diarrhoea?

A

an intestinal disorder characterised by an abnormal frequency and liquidity of faecal evacuations

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9
Q

how many children a year will get a diarrhoeal illness?

A

3-20%

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10
Q

what are the main causes of diarrhoea in developed countries?

A

IBS
IBD
malabsorption syndromes
chronic infections

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11
Q

what are the main causes of diarrhoea in developing countries?

A

bacteria
mycobacteria
parasites

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12
Q

what is secretory diarrhoea>

A

an increase in active secretion or inhibition of absorption e.g. cholera

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13
Q

what is osmotic diarrhoea?

A

too much water drawn into the bowels

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14
Q

what is exudative diarrhoea?

A

blood and pus in stool e.g. E.coli

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15
Q

what is inflammatory diarrhoea?

A

damage to the mucosal lining/brush border = loss of fluids and decreased ability to absorb

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16
Q

what is dysentry?

A

infection of the intestines that causes diarrhoea containing blood and mucus

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17
Q

whats the main causative organism of dysentry?

A

shigella

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18
Q

what are some consequences of diarrhoea?

A 
nutritional deficiencies e.g. anaemia, bleeding, bone disease
anorexia
weight loss
fatigue
oedema from protein deficiency
dehydration
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19
Q

why can diarrhoea cause anaemia?

A

iron, folate and B12 malabsorption

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20
Q

why can diarrhoea cause bleeding?

A

a vitamin K deficiency due to malabsorption of fat

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21
Q

why can diarrhoea cause bone diseases?

A

vitamin D and calcium deficiencies

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22
Q

what is coealiac disease?

A

an immunologically mediated inflammatory disorder due to the intolerance of gluten in genertically susceptible individuals

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23
Q

what genes have a strong association with coealiac diseases?

A

HLA-DQ2 mostly

some HLA-DQ8

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24
Q

when does coeliac disease typically begin?

A

childhood normally

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25
Q

where has the highest incidence of coeliac disease?

A

Ireland!

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26
Q

why does ireland have a high coesliac disease incidence?

A

as an irish diet is typically low in gluten

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27
Q

how does incidence in men vs women occur in coeliac disease?

A

women: males 2:1

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28
Q

what are the risk factors for coeliac disease?

A 
FHx
autoimmune thyroid disease
type 1 diabetes
IgA deficiency
Irritable bowel disorder
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29
Q

what are the 3 factors that cause coeliac disease?

A

genetic susceptibility
sensitivity to gliadin
environmental factors e.g. viral infection

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30
Q

what foods are gluten found in?

A

Barley
Rye
oats
Wheat

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31
Q

what is gliadin?

A

a class of proteins/gluten peptides present within the grass genus Triticum

32
Q

why are gluten peptides not completely broken down by digestive enzymes in the stomach?

A

gluten peptides are rich in proline and glutamine which prevents the totoal digestion, allowing gluten peptides to reach the small intestine

33
Q

outline the pathophysiology of coealiac disease?

A

gluten proteins enter the small intestine and cross gut epithelial cells. here tissue transglutaminase cuts off an amide group converting it to deamidated gluten proteins. These are taken up by APCs and served on MHC class 2 molecules coded for by specific HLA genes. CD4+ T cells recognise gliadin as foreign and start pumping out IgA antibodies against gliadin and tissue transglutaminase. They also recruit CD8+ T cells which destroy tissue and cause inflammation

34
Q

what is the endomysium?

A

a delicate network of connective tissue, which surrounds individual muscle fibres

35
Q

what structural changes does coeliac disease cause in the small bowel?

A

villous atrophy
crypt hyperplasia
increase in lymphocytes in lamina propria
cell death/tissue destruction

36
Q

what are the consequences of coeliac disease?

A

malabsorption - anaemia, weight loss, failure to thrive, steatorrhoea
malignancies
osteoporosis
neuropathies

37
Q

what malignancies can coeliac disease cause?

A

enteropathy-associated T cell lymphoma
Non-hodgkin lymphoma
adenocarcinoma

38
Q

how does coeliac disease usually present?

A

weight loss
chronic diarrhoea
anaemia
failure to thrive

may have abdo pain, altered bowel habits, bad smelling stool, bloating, depression, infertility

39
Q

what is dermatitis herpetiformis?

A

chronic, intensely itchy, blistering skin manifestation of celiac diseas

40
Q

how do we diagnosis coeliac disease?

A

SEROLOGY - TISSUE TRANSGLUTAMINASE ANTIBODIES, DEAMINATED GLIADIN PEPTIDE ANTIBODY AND ENDOMYCIUM ANTIBODY
FBC - detect anaemia and infections
endoscopy/tissue biopsy

41
Q

how do you treat coeliac disease?

A

gluten-free diet

supplements if malabsorption is causing deficincies

42
Q

what isa coeliac crisis?

A

a rare, life-threatening condiiton with unexplained diarrhoea, severe malabsorption and massive electrolyte imbalance

43
Q

how do we manage a coeliac crisis?

A

rehydration, electrolytes and corticosteroids to reduce inflammtion.

44
Q

what are soem differentials for coeliac disease?

A 
cow milk sensitivity
food-sensitive enteropathies
crohns disease
colitis
whipples disease
GIT lymphoma
IBS
45
Q

what is inflammatory bowel disease?

A

umbrella term to describe crohns disease and ulcerative colitis which vith cause inflammation of the GIT

46
Q

what is the average age for IBD to present?

A

15-40

47
Q

what mutations is crohns disease associated with?

A

NOD2 and IL-23

48
Q

what expresses NOD2?

A

paneth cells of the gut

49
Q

what is ulcerative colitis?

A

chronic inflammation in the mucosal layer of the GIT. Inflammation begins at the rectum and moves retrogradely through the colon

50
Q

what is ulcerative proctitis?

A

ulcerative colitis only in the rectum

51
Q

what is proctosigmoiditis?

A

ulcerative colitis in the rectum and sigmoid colon

52
Q

what is extensive colitis?

A

ulcerative colitis in the rectum, sigmoid and colon up to the splenic flexure

53
Q

what is pancolitis?

A

ulcerative colitis of the entire colon, including the caecum

54
Q

how does the onset of symptoms occur in ulcerative colitis?

A

slow and gradual, progressing over a few weeks

55
Q

what are the main symptoms of ulcerative colitis?

A

rectal bleeding
diarrhoea
general malais

56
Q

what are some extraintestinal manifestations of IBD?

A

arthritis, uveitis, episcleritis, pyoderma grangrenosum, erythema nodosum, primary sclerosing cholangitis and thromboembolism

57
Q

what are some acute complicatons of ulcerative colitis?

A

severe GI bleeds, fulminant colitis, toxic megacolon

58
Q

what are long term complications of ulcerative colitis?

A

colorectal cancer
severe dehydration
a perforated colon
bone loss

59
Q

outline what the mucosa looks like in ulcerative colitis?

A 
superficial ulceration (within the mucosa) that is continuous throughout an entire section. mucosa is friable to touch and can spontaneously bleed
damage is limited to mucosa and submucosa
60
Q

outline what the mucosa looks like in crohns disease?

A

muscle hypertrophy, fissures, cobblestone appearance, deep ulcerations

damage is transmural and extends from mouth-anus

61
Q

what are the main symptoms of crohns disease?

A

crampy abdo pain
general malaise
mucus and pus (steatorrhoea)

62
Q

what is a fistula?

A

an abnormal connection or passageway that connects two organs or vessels that do not usually connect

63
Q

how can the oral involveemnt of crohns disease present?

A

aphthous ulcers (canker sores), gingivitis and dysphagia

64
Q

which disease in IBD is more likely to cause kidney and gallstones?

A

crohns disease

65
Q

which disease of IBD has granuloma presence?

A

crohns disease

66
Q

what is fecal caprotectin?

A

a protein released in large amounts by neutrophils in the GI tract during inflammation

67
Q

what is mild ulcerative colitis?

A

<4 stools per day with or without blood with mild crampy abdo pain and occasional tenesmus

68
Q

what is tenesmus?

A

the feeling that you need to pass stools, even though your bowels are already empty

69
Q

what is moderate ulcerative colitis?

A

5 bloody stools per day, abdo pain, mild anaemia and somtimes a low grade fever

70
Q

what is severe ulcerative colitis?

A

6 or more bloody stools per day with severe abdo pain, fever, tachycardia, anaemia, elevated ESR and weight loss

71
Q

how do we treat ulcerative colitis?

A

aminosalicylates, corticosteroids

72
Q

what does the Crohns disease activity indec measure?

A 
stool pattern
general daily well-being over 7 days
complications
presence of abdominal mass
anaemia 
weight changes
73
Q

how do we treat crohns?

A 
no cure but can control symptoms!
corticosteroids
liquid diet
immunosupressants
biologics
surgery
dont take NSAIDs
74
Q

how does smoking affect prevalence of ulcerative colitis?

A

prevalenc of UC is less in smokers than in non-smokers

75
Q

what are the main susbtrate deficiencies in coeliac disease?

A

iron, folate and vit D and calcium

xB15W1 (9 decks)

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